Osler's node

Osler's node
Osler's lesions found on the hand and fingers of a 43-year-old male with subacute bacterial endocarditis
Differential diagnosis	infective endocarditis

Osler's nodes are painful, red, raised lesions found typically on the hands and feet.¹ They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition. Their presence is one definition of Osler's sign.²

Osler's nodes result from the deposition of immune complexes.³ The resulting inflammatory response leads to swelling, redness, and pain that characterize these lesions.

The nodes are commonly indicative of subacute bacterial endocarditis.⁴ 10–25% of endocarditis patients will have Osler's nodes.⁵ Other signs of endocarditis include Roth's spots and Janeway lesions. The latter, which also occur on the palms and soles, can be differentiated from Osler's nodes because they are non-tender.³

Osler's nodes can also be seen in

• Systemic lupus erythematosus
• Marantic endocarditis
• Disseminated gonococcal infection
• Distal to infected arterial catheter

Osler's nodes are named after Sir William Osler who described them in the early twentieth century.⁶⁷ He described them as "ephemeral spots of a painful nodular erythema, chiefly in the skin of the hands and feet."¹